Serum estradiol and sex hormone-binding globulin and the risk of hip fracture in elderly women:: The EPIDOS study
Serum estradiol and sex hormone-binding globulin and the risk of hip fracture in elderly women:: The EPIDOS study
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DOI：
10.1359/jbmr.2000.15.9.1835
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发表时间：
2000-09-01
影响因子：
6.2
通讯作者：
Delmas, PD
中科院分区：
文献类型：
--
作者：
Chapurlat, RD;Garnero, P;Delmas, PD
已有研究表明，血清17β-雌二醇(E_2)和性激素结合球蛋白(SHBG)水平降低可预测绝经后妇女髋部骨折的发生。我们在7598名年龄在75岁或以上的健康老年流动妇女(EPIDOS研究)的大型前瞻性队列中，调查了血清E2和SHBG浓度以及尿脱氧吡啶(D-PYR)和I型胶原分解产物(CTX)的预测价值。我们进行了一项嵌套式病例对照研究，将212名髋部骨折患者与636名对照进行匹配。平均随访3.3年(最长4.9年)。血清雌二醇水平低于检测下限(3pg/ml)的妇女，即2%的人口，没有更高的风险，相对危险度(RH)为1.59(95%CI=0.45-5.55)。血清雌二醇低于5、6、7或8 pg/ml、处于最低四分位数或低于中位数的女性患髋部骨折的风险没有增加。相比之下，血清雌二醇处于最高四分位数(即大于或等于10pg/ml)的女性受到保护，RH为0.66(0.44-0.98)，经体重调整后不再显著(RH=0.71[0.47-1.06])。不同截断值的高血清SHBG值往往与髋部骨折风险增加有关。四分位数最高的女性的相对湿度为2.5(1.37-4.61)，而四分位数最低的女性的相对湿度在调整体重后显著下降(1.61[0.99-2.62])。E_2/SHBG比值的最高四分位数是游离E_2的指标，与较低的髋部骨折风险(RH=0.6[0.4-0.91])有关，在调整体重后，这种风险不再显著。相反，当尿D-PYR和CTX高于绝经前的上限时，即使在调整了体重、血清E_2和SHBG后，预测髋部骨折的RH分别为2.07(1.49-2.9)和1.67(1.19-2.32)。我们的结论是，在75岁以上的健康老年法国女性中，血清E2和处于最高四分位数的E2/SHBG与较低的髋部骨折风险相关，这种关联是由较高的体重解释的。此外，血清E2和SHBG水平不能解释高水平骨吸收标记物增加髋部骨折的风险。
It has been suggested that low serum 17 beta-estradiol (E2) and sex hormone-binding globulin (SHBG) may predict hip fracture in postmenopausal women. We have investigated the predictive value of serum E2 and SHBG concentrations and urinary deoxypyridinoline (D-Pyr) and type I collagen breakdown products (CTX) in a large prospective cohort of 7598 healthy elderly ambulatory women (EPIDOS study), aged 75 years or more. We performed a nested case control study, by matching 212 patients with incident hip fracture with 636 controls. Mean follow-up was 3.3 years (maximum, 4.9 years). Women having serum E2 below the limit of detection (3 pg/ml), that is, 2% of the population, were not at higher risk, with a relative hazard (RH) of 1.59 (95 % CI = 0.45-5.55). Women having serum E2 below 5, 6, 7, or 8 pg/ml, in the lowest quartile, or below the median had no increased risk of hip fracture. In contrast, women having serum E2 in the highest quartile (i.e., greater than or equal to 10 pg/ml) were protected, with an RH of 0.66 (0.44-0.98) that did not remain significant after adjustment for weight (RH = 0.71 [0.47-1.06]). High serum SHBG values with different cut-offs tended to be associated with an increased risk of hip fracture. Women in the highest quartile had an RH of 2.5 (1.37-4.61), compared with those in the lowest quartile, that decreased markedly after adjustment for body weight (1.61 [0.99 -2.62]). The highest quartile of the ratio E2/SHBG, which is an index of free E2, was associated with a lower hip fracture risk (RH = 0.6 [0.4-0.91]) that was no longer significant after adjustment for weight. In contrast, urinary D-Pyr and CTX, when elevated above the upper limit of premenopausal values, were predictive of hip fracture, with an RH of 2.07 (1.49-2.9) and 1.67 (1.19-2.32), respectively, even after adjustment for body weight, serum E2, and SHBG. We conclude that in healthy elderly French women over 75 years of age, serum E2 and E2/SHBG in the highest quartile are associated with a lower risk of hip fracture and that this association is explained by a higher body weight. In addition, serum levels of E2 and SHBG do not account for the increased risk of hip fracture associated with high levels of bone resorption markers.